MS, Cabinet Secretary for
Health and Social Care: I am today publishing
the Quality Statement for
Osteoporosis and Bone Health, which sets out our vision
for the better care and services throughout a person's life,
especially for those people who are at the highest risk of
suffering a fragility fracture.
Fragility fractures affect half of women over the age of 50, and
a fifth of men. They can have significant impacts on a person's
quality of life. Following a first fracture, there is a
one-in-three chance of sustaining another fracture within 12
months.
Osteoporosis is often diagnosed following a fragility fracture
but subsequent re-fractures can lead to an accumulation of
fracture-specific morbidity over time. This is described as the
fracture cascade. Our approach must be to promote bone health for
everyone – starting from pre-conception throughout people's
lifetime.
The quality statement has been developed in collaboration with
the national clinical leads for osteoporosis and bone health,
with input from the strategic clinical network for
musculoskeletal health, third sector partners, those with lived
experience and bone health colleagues across Wales. It sets out
where we expect to see the NHS focus on the planning of services
and how national support will enable improvement.
Our aim is to improve and protect the bone health of the
population by providing the overarching framework for the
delivery of care for people with osteoporosis, from prevention,
treatment to supporting people's recovery. The national and
regional pathways developed will drive system-wide improvement
through a reduction in variation of care and improved outcomes.
Good progress is already being made as fracture liaison services
have been rolled out across Wales. These ensure people aged 50
and over who have experienced a broken bone after a fall have
their bone health and falls risk checked and managed to reduce
the risk of a subsequent refracture. The services include a team
of healthcare professionals and have been shown to benefit
individuals and be both a clinically and cost-effective form of
early intervention.
But the journey does not end there. Each health board has made a
long-term commitment to continue to develop and improve services
to support the needs of their local communities and to reduce the
impact falls and fractures have on individuals and the NHS.
This must include a continuous focus on achieving the key
performance indicators. The minimum standards for quality
fracture liaison services are to identify 80% of the expected
fragility fractures, start treatment for 50% and monitoring 80%
of those who have commenced on bone treatment at 16 weeks and 52
weeks.
This standard is not currently being met in Wales and health
boards are at different stages in establishing their fracture
liaison service. However, there is a clear commitment and
ambition from all health boards to meet national standards and
provide quality care.
That is why today, I am announcing a new commitment to achieve
the 80/50/80 national fracture liaison service standard in Wales
by 2030.
To ensure Wales offers equitable and quality osteoporosis and
bone health care, our focus in the next phase of this work will
be to nurture the ongoing development of services and continuing
to work with Powys teaching Health Board to strengthen its
fracture liaison service provision.
We will work with the strategic clinical network for
musculoskeletal health to support health boards to deliver the
aspirations set out in the quality statement for osteoporosis and
bone health, including the 80/50/80 standard.
Timely access to Dual-Energy X-ray Absorptiometry (DXA) services
is also essential. DXA is a medical imaging technique used to
measure bone mineral density; it is considered the gold standard
for diagnosing osteoporosis and assessing fracture risk. The
results from a DXA scan help clinicians evaluate bone health,
monitor changes over time, and guide treatment decisions.
DXA services in Wales are facing a number of challenges in
relation to capacity, quality and workforce. Our national
clinical lead for falls and fragility, Dr Inder Singh, and the
FLS Quality Assurance and Development Group will work with health
boards over the coming 12 months to address the backlog in DXA
services, improve access to scans and reporting, and invest in
workforce training and development.
